Food Security (2018) 10:1547–1559

https://doi.org/10.1007/s12571-018-0847-7

ORIGINAL PAPER

The Brazilian food security scale for indigenous Guarani households:

Development and validation
Ana Maria Segall-Corrêa 1 & Leticia Marín-Leon 2 & Marta Maria do Amaral Azevedo 3 & Maria Beatriz R. Ferreira 4 &
Deoclécio Rocco Gruppi 5 & Daniele F. M. Camargo 2 & Rodrigo Pinheiro de Toledo Vianna 6 & Rafael Pérez-Escamilla 7

Received: 26 July 2017 / Accepted: 8 October 2018 / Published online: 26 October 2018
# Springer Nature B.V. and International Society for Plant Pathology 2018

Abstract
In Brazil there are 817,963 Indigenous people distributed across 305 ethnic groups, and speaking 274 different languages. The
objective of this paper was to develop and validate an experience-based household food security measurement scale among the
Guarani people. A mixed-methods study was conducted between 2007 and 2012 in four Guarani communities located on the coast
of Sao Paulo. The qualitative phase involved developing an 11-item scale in full consultation and partnership with representatives
from the Indigenous communities. Psychometric testing was conducted in 3 villages from 2011 to 2012 by applying the scale
predominantly to adult women. Selected nutritional and social indicators were collected for testing the scale’s external validity.
Psychometric testing was done with the Rasch model (N = 88). Severity scores of items followed the theoretically expected ranking
order. Nine out of the 11 scale items had an adequate fit to the whole scale (Binfit^ values ranging from 0.8 to 1.3). Three of these 9
items had severity scores that were very similar to other scale items indicating redundancy of information and thus two of them were
dropped from the scale. The final scale was translated into Guarani confirming the face validity of questions and response options
for households with children and adolescents. In conclusion, it was possible to develop a valid experience-based Brazilian Food
Security Scale for Indigenous Guarani People (EBIA-G) that can now be tested among diverse Indigenous groups in the country.

Keywords Food security . Measurement . Scale . Psychometric . Indigenous communities . Validation . Brazil

1 Introduction Europeans in the sixteenth century, and this community

identifies the individuals as belonging to its collectivity
Legally speaking the Brazilian Government considers individ- (Brasil 2010). This legal definition is supported by ILO
uals as being indigenous if they belong to a community of Convention 169 (International Labor Organization 1989). In
people who already lived in that territory before the arrival of addition, all individuals who recognize themselves as indige-
nous may self-identify, or self-declare as such when responding
to the country’s Demographic Census (IBGE 2012).
* Ana Maria Segall-Corrêa
amsegall@uol.com.br
According to the 2010 national census (IBGE 2010a, b)
Indigenous communities, represent about 0.4% of the
Brazilian population or 817,963 individuals. Although distrib-
1
Program of Food, Nutrition and Culture-Oswaldo Cruz Foundation – uted throughout the nation, Indigenous peoples are more con-
Fiocruz, Brasilia, DF, Brazil
2
centrated in the Midwest and Northern regions. The census
Department of Collective Health- Faculty of Medical identified 305 different ethnic groups speaking 274 different
Science-UNICAMP, Campinas, Brazil
3
languages indicating great ethnic and cultural diversity. Over
Center for Population Studies-NEPO-UNICAMP, Campinas, Brazil half of the Indigenous populations (57.3%) live in areas offi-
4
Faculty of Education-UFGD, Dourados, Brazil cially recognized as Indigenous territories. The others live in
5
Department of Physical Education-UNICENTRO/Pr, geographical areas still not officially recognized as such or are
Guarapuava, Brazil Indigenous communities settled in urban and peri-urban areas.
6
Health Science Center – UFPB, Paraíba, Brazil The Indigenous people represent one of the most vulnera-
7
Department of Social and Behavioral Sciences, Yale School of Public ble populations in Brazil from the social as well as health
Health, New Haven, CT, USA perspectives (Coimbra et al. 2013; Benzaken et al. 2017).
1548
Their communities constantly face threats to their physical,
cultural, and territorial integrity (Coimbra 2014; FIAN-
Internacional 2015). According to the first Brazilian
Indigenous health and nutrition survey in 2010 (Cardoso
et al. 2009; Coimbra 2014), the prevalence of stunting among
children under five years of age was 26%, a prevalence 3.7
times higher than the national average. On the other hand, the
prevalence of overweight and obesity among Indigenous
women of reproductive age of 32.7% is similar to the preva-
lence observed in the corresponding general population.
Chronic diseases commonly found in the general population,
such as diabetes and hypertension, are also highly prevalent
among Indigenous people, perhaps as a result of major chang-
es in dietary and physical activity patterns (Gugelmin and
Santos 2001). The seriousness of this situation is supported
by the recent detection of metabolic syndrome among
Indigenous women (Anjos et al. 2011). Pneumonia is the top
reason for hospital admissions among Guarani children
followed by bronchitis and other respiratory illnesses
(Cardoso et al. 2010). Iron deficiency anemia, malnutrition,
dehydration, diarrhea, sepsis, and skin infections are also fre-
quent reasons for hospital admissions among Indigenous
young children (Brandelli et al. 2012). Anemia is highly prev-
alent among adult women and children (Cardoso et al. 2009;
Orellana et al. 2011). Parasitic infections are also highly prev-
alent, especially among children, and can result in vitamin
deficiencies and chronic undernutrition (Brandelli et al.
2012). Moura et al. (2010) found that child undernutrition
coexists with obesity in Indigenous communities that have
undergone major environmental and cultural changes to the
detriment of the quality of their diets and their overall nutri-
tional status. By contrast Indigenous people living in commu-
nities with less contact with non-indigenous environments had
better food habits and nutritional status, probably because they
still fish, hunt, and gather food, which involves intense phys-
ical activity (Gugelmin and Santos 2001).
There are few studies on Indigenous peoples that address
the issue of regular access to a specific diet in terms of quantity
and quality for their cultural and nutritional needs, among
them Leite et al. (2007) on Wari-Amazon. This study ad-
dresses the issue of seasonality of food sources and its effect
on the Wari’s nutritional status at all ages, showing the need to
include this dimension in future research.
Although still scarce, studies that collect health and nutri-
tion information based on indirect indicators of food security
are much more common than studies that address directly the
multiple dimension of food access. At the present time very
few studies have been conducted in Brazil to understand sus-
tainable access to an adequate diet among Indigenous people.
Such studies are needed to help preserve the integrity of food
production, the environments where it is obtained or grown,
respecting local traditions and customs, as called for by the
Brazilian food sovereignty definition in the context of the
A. Segall-Corrêa et al.
Brazilian Food Security Law (Brasil 2006): Food and
Nutrition Security is the realization of the right of all to reg-
ular and permanent access to quality food of sufficient quan-
tity, without compromising access to other essential needs,
based on practices that promote health, respect the people's
cultural diversity and that are socially, economically and en-
vironmentally sustainable.
The BHunger map among the Indigenous communities in
Brazil^ published in 1995 was the first attempt to understand
the conceptualization of food sovereignty and food security in
these communities (Verdum 2003). The authors used indica-
tors reflecting the legal status of their territories, malnutrition,
infant mortality, environmental conditions, and indirectly es-
timated different degrees of severity of food insecurity. Out of
297 Indigenous areas studied, 66.7% had dfficulty in
obtaining access to enough food for a healthy life permanently
or seasonally, and in 44% of these areas there was evidence of
hunger (Verdum 2003).
Between 2003 and 2004 the experience-based Brazilian
Food Insecurity Scale (EBIA) was developed and validated
(Pérez-Escamilla et al. 2004; A. M. Segall-Correa et al. 2009)
using as starting point the United States Household Food
Security Measurement Module developed in the early 1990s
(Bickel et al. 2000; Radimer 2002). EBIA was successfully
applied in three subsequent nationally representative surveys
(IBGE 2010a, b; IBGE, Instituto Brasileiro de Geografia e
Estatística 2014). However, EBIA was not recommended for
use with Indigenous communities as these communities were
not included in the development and validation process of the
scale, and the scale for the general population was not devel-
oped with linguistic and cultural adaptations specific to
Indigenous communities (Segall-Correa et al. 2010).
A first attempt in Brazil to measure directly food
(in)security in an Indigenous community using an
experience-based scale took place in an Indigenous village
inhabited by the Terena Indigenous people in Mato Grosso
do Sul State. A local adaptation of EBIA (Fávaro et al.
2007) found 32.7 and 20.4% of households living with mod-
erate and severe food insecurity, respectively. A few years
later, a study using another local adaptation of the EBIA iden-
tified extreme food vulnerability among Guarani M’bya in
Espírito Santo State; none of the households in this village
had full access to the food they needed, and 41% were
experiencing severe food insecurity (Vargas et al. 2013). A
recent study (Franceschini 2016) that applied an adapted ver-
sion of the EBIA to four communities of Guarani and Kaiowa,
living in vulnerable and violent areas in the State of Mato
Grosso do Sul, found severe food insecurity in 28% of house-
holds, a prevalence almost 9 times that of the national average
of 3.2% (IBGE, Diretoria de Pesquisa, and Coordenação de
Trabalho e Renda 2014). The authors concluded that these
findings could be explained not only by the recognized social
vulnerability of Indigenous people, but also by the cultural
The Brazilian food security scale for indigenous Guarani households: Development and validation
and language inadequacies of the EBIA. The same hypothesis
motivated a study on the psychometric behavior of a
Household Food Security Scale (HFSS) applied to
Indigenous people in Canada (Teh et al. 2017). These results
and arguments strongly support the need to develop and test
an experience-based scale to measure food insecurity in
Indigenous communities in Brazil.
This paper reports the findings from the third phase of a
mixed-methods study designed to understand the concepts,
knowledge and perceptions of food insecurity among
Guarani Indigenous People in the State of São Paulo, Brazil
(Segall-Correa et al. 2010) as the basis for the development
and psychometric validation of a Guarani Household Food
Insecurity Scale (EBIA-G).
2 Methods
The study enrolled Indigenous participants of four Guarani
communities located on the coast of the State of São Paulo.
These communities were selected because the research team
included an anthropologist very familiar with Guarani culture
and, due to resource constraints, the need to work in
Indigenous communities located not very far from the
UNICAMP campus in the city of Campinas-São Paulo. The
chosen communities were the Indigenous lands (IL) of: BRio
Branco IL^ (tekoha Yyti) consisting of 2856 ha where 40
families were living in 2008; the BRio Silveira IL^ with
8500 ha and about 376 inhabitants, located in the State Park
of Serra do Mar, an environmental unit; the BPiaçaguera IL^
with 2795 ha and 218 inhabitants; the BAldeinha^ community,
which is not an Indigenous land, but an urban neighborhood
of the city. This territory, which is occupied by 78 individuals
from an extended family, has not yet been officially recog-
nized. Three ethnic Guarani groups, Mbyá, Ñandeva and
Tupi-Guarani, were living in the four Guarani communities
during the study period.
The development and validation of the Brazilian
Household Food Insecurity Scale for Guarani Indigenous
communities (EBIA-G) involved three steps (Fig. 1). The first
step was carried out to introduce the project to the Guarani
communities and to obtain the community approvals needed
for the research to be carried out. Four out of five Guarani
communities located in the North and South of São Paulo
Coast agreed to participate. A social, nutrition and health sur-
vey was applied between 2007 and 2008 to all 115 households
enrolled in the research study.
The second step was a qualitative study (unpublished) that
lasted three years (2008 to 2010) and involved intensive con-
tact with the Guarani people through informal talks, meetings
with Indigenous leaders and professionals, and 3 focus groups
with their methods adapted to Guarani culture. In this phase,
we identified how the Guarani defined the construct of food
1549
security and its key elements. Guarani statements on their
conceptualization of food security/insecurity and hunger
resulting from the focus groups were grouped according to
the theoretical model that took into account the food insecurity
dimensions considered to be universal: a) worry (anxiety or
uncertainty) about obtaining food in the near future; b) poor
dietary quality; and c) strategies to manage household food
insecurity, (Coates et al. 2006; Swindale and Bilinsky 2006).
The product of these meetings was the first version of
EBIA-G (Table 1) for families with no children and the com-
plete EBIA-G for families including children. The Guarani
conceptualization of Bfamily^ and Bhousehold^ was also
discussed. During this phase we established the selection
criteria for the Guarani interviewers for the subsequent steps
of the study: (i) a good understanding of the study, (ii) in-
volved in the previous research phase and (iii) fluency in
Portuguese and Guarani languages. Based on feedback from
the Indigenous interviewers it was also decided that the ques-
tionnaire respondents should be adult women with knowledge
of the food situation and feeding habits in the household.
Interviewers were trained on how to recruit participants, how
to apply the human consent form, and on the best way to
approach the respondents and apply the questionnaire.
EBIA-G and a set of selected indicators on social and de-
mographic status were pretested with 14 families. Feedback
from the Indigenous interviewers and the data analysis of the
pre-testing phase identified the need for further rewording and
refinements of EBIA-G and of reducing the number of health
and social indicators. The internal (psychometric) and external
validation of EBIA-G was conducted in the third phase.
Community surveys were carried out from 2011 to 2012 and
a final questionnaire, containing the revised EBIA-G and the
socio-demographic indicators (family composition, sex and
age of household members, level of formal education, fluency
in Portuguese and Guarani language, occupation, monetary
income and non-monetary resources of the head of household)
was applied in three Guarani territories where all eligible
households were included: Rio Silveira IL (N = 54), Boa
Vista IL (N = 20), Ubatuba and Piaçaguera ILs (N = 39). Boa
Vista IL was chosen to replace Aldeinha and Rio Branco with
the objective of including a group of households that was not
exposed to the previous Phases. This allowed us to
identify any remaining difficulties in understanding con-
cepts and item structures.
From the 115 households invited to participate in the study,
6 refused, 15 had incomplete questionnaire responses, and 6
were withdrawn because there was no information about the
existence or not of children in the household. The internal and
external validity analyses included 88 households with com-
plete EBIA-G data. It is important to emphasize that the cho-
sen Guarani communities are not representative of other
Guarani people or other Indigenous groups. The intent of this
study was to start the process of development of an Indigenous
1550 A. Segall-Corrêa et al.

Fig. 1 Indigenous food insecurity

research study design. 2007 - 2008
EBIA-G: Guarani-Brazilian Ethics approvals from government
food insecurity scale and indigenous communies

2008
Seminar with
indigenous research
specialists

2008
2009-2010 2010
Health and nutrion survey,
Individual observaons Meengs with
assessing tradional
and small group indigenous leaders
physical acvies and
discussions and professionals
migraon movements

2011
3 focus groups: Adult Men, Adult women and Youth

2011
2011 2012
2 Meengs with
Household Final meeng with indigenous
indigenous
professionals to surveys to test people to discuss their study
develop EBIA -G EBIA -G experience and finalize EBIA-G

food insecurity scale based on Guarani concepts and experi-
ence and, if the resulting scale looked promising, form
a psychometric perspective to expand the work into oth-
er ethnic groups.
Once the purpose of the study was explained, the
household members who agreed to participate signed
an informed consent form. The research project was
approved by the Ministry of Health Human Subjects Research
Ethics Committee (CONEP N° 1102/2006).
After finishing the household survey, a last meeting was
conducted with Indigenous interviewers to present the re-
search results and to discuss their field experiences and
recommendations.
2.1 Data analyses
The psychometric validation of EBIA-G was conducted with
a single parameter logistic Rasch model (Bond and Fox 2001;
Vianna et al. 2012). This model analyses binary responses
(correct/incorrect or yes/no), to a series of items capturing
progressive degrees of Bdifficulty^ or Bseverity^. This statis-
tical technique has been used in previous studies to test the
internal psychometric validity of food security scales that at-
tempt to capture a unidimensional construct. The construct is
based on a theoretical framework that considers food insecu-
rity as a phenomenon with different severity levels, which are
reflected in the number of affirmative responses to the scale
items (Melgar-Quinonez et al. 2007; Vianna et al. 2012).
According to the Rasch model assumptions, on the one hand
respondents from households experiencing less severe food
insecurity will have a lower probability of affirming items that
capture the more severe aspects of food insecurity. On the
other hand, respondents living in moderate or severe food
insecure households will be more likely to affirm these same
items (Smith et al. 2002). The statistical parameters reported
from the Rasch model psychometric testing were the severity
scores and fit to the scale of each of the items conforming it.
The severity of the item in the context of the pattern of
responses to all items allows for the mapping of the
relative position of each item in a log-odds scale. The
items that are affirmed less frequently are those that in princi-
ple should be capturing the more severe aspects of food inse-
curity and vice versa.
The fit statistics were computed, based on squaring the
difference between the expected and observed severity for
each item and are reported as the average of the residual
squared (Vianna et al. 2012; Bond and Fox 2001). The fit
statistics were generated to examine the adequacy of the
The Brazilian food security scale for indigenous Guarani households: Development and validation 1551

Table 1 Pre-tested Guarani food [in]security scale module(EBIA-G) used in the household surveys in the villages BRio Silveria^. BPiaçaguera^ and
BBoa Vista^ in the State of São Paulo - Brazil

Item-\Portuguese* Item\English*** It Item em Guarani**

1 Alguma vez, no mês passado, você
sentiu preocupação em conseguir
comida para sua casa?
2 Alguma vez, no mês passado, vocês
desta casa comeram comida de
sua cultura?
3 Vocês nesta casa alguma vez no mês
passado comeram comida boa (do gosto)?
4 Vocês nesta casa alguma vez no mês
passado comeram comida saudável?
5 No mês passado a comida que vocês
tiveram foi de quantidade suficiente
para alcançar o mês inteiro?
6 Alguma vez no mês passado, você
passou o dia todo sem comer nada,
porque não tinha comida na casa?
7 No mês passado, alguma vez, você teve
que comer menos comida para deixar
comida para as crianças e jovens
menores de 16 anos?
8 Alguma vez no mês passado as crianças
e jovens menores de 16 anos da casa
comeram comida boa (do gosto)?
9 Alguma vez no mês passado as crianças
e jovens menores de 16 anos da casa
comeram comida que faz crescer
com saúde:
10 Alguma vez no mês passado as crianças
e jovens menores de 16 anos da casa
comeram menos quantidade de comida
do que é necessário, porque tinha
pouca comida?
11 Alguma vez no mês passado as crianças
e jovens menores de 16 anos da casa
passaram o dia todo sem comer e foram
dormir querendo comer porque não
tinha comida?
At any time, during the last month,
did you feel worried about getting
food for your household?
At any time, during the last month, did
you and your family eat food of
your culture?
At any time, during the last month, did
you and your family eat food of your
preference?
At any time, during the last month,
did you and your family eat healthy food?
During the last month, did you and your
family have a sufficient amount of food
for the whole month?
At any time, during the last month, did
you run out of food for the whole day?
At any time, during the last month, did you
have to eat less to leave food for the
children under 16?
At any time, during the last month, did the
children under 16 of the household eat
good food (of preference)?
At any time, during the last month, did
the children under 16 of the household
eat food that makes them grow healthy?
At any time, during the last month, did the
children under 16 of the household eat
less food than necessary because there
was not enough food?
At any time, during the last month, did the
children under16 go for a whole day
without eating and went to bed hungry
because there was no food?
Amonguepypa rejepy’apyarendúpa
peteĩ jaxyre nderópy rejouãguã
ekaru’iãguã
Amonguepy pa tembi’uete’i
pe’úpa jepi peteĩ jaxýre:
Amonguepy pa tembi’uporã
pe’úpa jepi peteĩ jaxýre:
Amonguepy pa tembi’urexãi
pe’úpa jepi peteĩ jaxýre
Tembi’u rerekoa’e ogueropo’akanhi’a
raka’e peteĩ jaxy oaxa va’ere
Amongue arápy tembi’u axyreiramo
ndererekoivy mba’eve nderópy
re’u ãgua peteĩ jaxýre?
Peteĩ jaxýre amonguepy pa tembi’u
pereko teĩ karuai peaxa kyrynguere
ema’evy?
Amongue jaxýre pa tembi’u porã
pende ra’y kuery o’upa
Amongue jaxýre pa tembi’u porã
pende ra’y kuery o’upa: Rever
Amongue jaxýre pa pende ra’y kuery
ndokaru porã porãi jepipa tembi’u
noĩ porã porãi ramo?
Amongue jaxýre pa kyringue arapukure
ndokarui há’e oke okaruxereve
tembi’u ndaipoiramo?

Item response options: *Não, Nenhuma Vez; Sim Poucas Vezes; Sim, Muitas Vezes/
**No, Never; Yes, a Few Times; Yes, Many Times
*** amongue’ipy; jepi atyramiae; nem eteĩguevema

psychometric behavior for each item with respect to the whole
EBIA-G. The fit values were considered to be adequate if they
fell within the 0.7 to 1.3 range (Bond and Fox 2001). Rasch
analyses were conducted with WINSTEPS (version 3.72).
To run the Rasch Model, all items (Table 2) were trans-
formed into dichotomous variables (yes/no). The category
Byes, few times^ was classified as Byes^ in items affirming
food insecurity (item 1, 6, 7, 10 and 11) and as Bno^ for items
affirming food security (item 2, 3, 4, 5, 8 and 9).
The external or predictive validity of EBIA-G was based on
first classifying households according to different severity
levels of food insecurity. Subsequently a set of selected indi-
cators was used to generate contingency tables to verify the
expected associations between household food insecurity sta-
tus and the following socio-demographic indicators: family
composition, age, sex, level of formal education, occupation,
proficiency in Portuguese and Guarani languages of the head
of household. According to Gordon (2006) Bthe progressive
Indigenous contact with non-indigenous societies and their
confinement in ever-shrinking territories promoted changes
in the people’s way of living leading as a result to a new
working pattern and survival strategies with their incorpora-
tion, specially the Guarani, in the labor market^. The pro-
posed indicators were considered adequate, based on empirical
evidence and theoretical considerations, to test the predicitve
validity of the scale. Pearson’s chi-square analyses and Fisher
1552 A. Segall-Corrêa et al.

Table 2 EBIA-Guarani items exclusion according to the item infit and severity values. Brazil- 2012

Scale items 11 items 10 items 9 items 8 items 7 items 6 items

Infit Sev. Infit Sev. Infit Sev. Infit Sev. Infit Sev Infit Sev.

1 Adult worried about food sufficiency 1.19 5.22 1.25 4.94

2 Household food of the culture 1.71 3.50
3 Household tasty food 1.03 5.33 1.12 5.06 1.20 4.90 1.26 4.67
4 Household healthy Food 0.79 5.00 0.90 4.70 0.92 4.52 0.93 4.27 0.92 3.93 1,11 3.50
5 Household enough food 1.05 5.22 1.13 4.94 1.22 4.78
6 Adult the whole day without eating 0.90 8.52 0.87 8.34 0.88 8.3 0.82 8.28 0.72 8.25 0.85 8.00
7 Adult ate less for leaving for Children 0.85 6.68 0.84 6.46 0.88 6.36 0.91 6.23 0.91 6.07 0.76 5.70
8 Children ate good food (tasty) 0.80 5.11 0.93 4.82 0.94 4.66 0.92 4.41 1.00 4.08
9 Children food for growing healthy 0.78 5.22 0.83 4.94 0.85 4.78 0.82 4.54 0.93 4.23 1.06 3.80
10 Children ate less 0.82 6.92 0.79 6.71 0.78 6.62 0.82 6.50 0.78 6.37 0.71 6.00
11 Children whole day without eating 1.13 9.26 1.14 9.08 1.13 9.07 1.11 9.10 1.10 9.08 1.17 9.00

exact tests were used to compute the statistical significance of
associations using p < 0.05.
3 Results
The advisory group discussion in the study’s second phase,
confirmed by Guarani members and researchers, proposed an
11 item scale, seven related to households adults experiences
and four related to the children’s dietary quality and sufficien-
cy (Table 2). Since the Indigenous focal group participants did
not reach consensus about which item(s) could better explain
household access to a diet of quality three items were included
for testing, thus leading to a more adequate choice:
Bhousehold members had access to food of their culture^,
Bhousehold members had access to food of their preference^
and Bhousehold members had access to a healthy food^. To
identify specific child dietary quality another item was sug-
gested: Bchildren had access to food that allow them to grow
healthy^. The focal group also suggested that the scale should
be available in Portuguese and Guarani and questions asked
should always denote a positive food security outcome as it’s
customary in their culture. For example the wording for Byour
family did not have enough food for the entire month?^ was
changed to Byour family had enough food for the entire
month?^
As a result the number of response options was changed
from Byes/no^ to BBno, never^, Byes, only a few times^, Byes,
many times.^ This was recommended to avoid classifying
households as food secure if they experienced a food security
situation only a few times, during the previous month. For
example, the question BThe household members ate foods
from their culture during the previous month?^ may be
responded as Byes^ even if they had actually done so only
for a few times during the previous month.
The community members pointed out that there is a strong
feeling of shame when they have no way of feeding their
children. Therefore, the word Bhunger^ was suppressed to
avoid embarrassing the person being interviewed; especially
the head of household. BHunger^ was replaced with the sen-
tence Bchildren didn’t eat the whole day and went to sleep
without having eaten^. The community feedback also indicat-
ed that the EBIA-G respondent should preferably be an adult
woman living in the household because they were expected to
understand better the food dynamics in the family and to be
less resistant to acknowledge food insecurity problems.
The household was characterized as the family unit where,
independently of blood relationship, age or number of mem-
bers, the interdependence among members, especially with
regard to food is found. The time reference period that
respondents would be asked to recall was defined as the
month prior to the interview, a period that coincided
with the lunar calendar, traditionally used to keep track of time
in the target communities.
The villages are organized in groups of households, known
as Tekoha. It is considered a Bphysical place, land, forest, field,
waters, animal, plants, remedies, etc. – where the teko, or Bway
of being^, the Guarani state of life, is realized. It encompasses
social relations of macro-familial groups who live in and are
related in a specific physical space^ (Socioambiental 2017).
The study areas had a predominantly young population
with 50% younger than 15 years old and the median age of
the head of households was 35 years. Main income sources
were craft sales or public sector employment. The great ma-
jority of the households were enrolled in the BBolsa Família
Program^ (88.3%), a conditional cash transfer program.
Household living conditions were precarious as no sewage
system was available and 60% disposed their garbage in the
areas surrounding the household. In one of the communities
(Rio Silveira) the foods provided by the School Food Program
The Brazilian food security scale for indigenous Guarani households: Development and validation 1553

funded by the municipality were shared by all household
members for lunch times but only during week days.
Therefore, this food assistance was not available for dinner,
holidays, Saturdays, Sundays and during school vacation pe-
riods. Prevalence of stunting in children under 5 years of age
was very high (52.8%), and, at the same time, there was also a
relatively high prevalence of overweight among children
(10.1%) and much higher among women of reproductive age
(44.7%).
3.1 EBIA-G internal (psychometric) validity
Rasch analytical procedures were used to assess the psycho-
metric behavior of EBIA-G, based on the severity scores and
infit values for each of the 11 items. After the initial analysis,
items without adequate psychometric behavior were removed
systematically until the optimal composition of the scale was
obtained taking into account both the psychometric behaviors
as well as the theoretical framework behind the scale.
Of the 11 items initially analyzed only the item Bhousehold
cultural food^ had a poor fit to the scale and it was withdrawn.
In addition, three items had the same severity scores (5.22)
indicating that they were redundant. These were the BAdult
worried about food sufficiency^, BHousehold enough food^,
BChildren food for growing healthy^ items. The ordering of
EBIA-G items, based on their severity scores, was con-
sistent with the expectation: items that captured the
more severe aspects of food insecurity (such as adult or child
spending a whole day without food) had the highest severity
After running again the Rasch analyses we found optimal
infit values for 7 out of 8 items: the item BHousehold tasty
food^ had an infit value close to the upper limit (1.26)
and it was marked for exclusion. At this round of anal-
ysis there were no longer items capturing the same se-
verity values although three items were very close, including
BHousehold tasty food^. It confirmed the exclusion decision
without compromising the ability of the scale to discriminate
among different levels of HFI.
The 7-item scale version had adequate infit values for all
items. However, two items presented similar severity scores:
BHousehold healthy foods^ (3.93) and BChildren ate good
food^ (4.08). Analysis of the structure of the scale showed
that three items represented dietary quality (two of them refer-
ring to children), two items dietary quantity of adults, and two
items dietary quantity among children. Because the severities
were similar between the two items referring to dietary quality
among children, the item BChildren ate good food^ was re-
moved. This decision was also made because the wording of
this item may be very specific to the Guarani context and
perhaps not applicable to other Indigenous ethnic groups.
The final round of Rasch analysis showed that all six items
had adequate infit values with severity values well distributed
across the range of scores and following theoretical expecta-
tions (Fig. 2). This confirmed the better version of the scale
with regard to its rank ordering i.e. dietary quality is affected
EBIA-G six item infit values
1.6

scores (Table 2). 1.17 1.11

1.2 1.06
After removing the item Bhousehold cultural food^, the
Infit values

0.85
second round of Rasch analysis was based on the 10-item 0.8
0.76 0.71
EBIA-G, that showed a good fit to the complete scale, based
on infit values ranging from 0.79 (BChild ate less^) to 1.25 0.4
(BAdult worried about food sufficiency^). Severity of the
items ranged from 4.7 (BHousehold healthy foods) to 9.10 0
(BChild whole day without eating^). The same three items Ch whole HH Ch food Ad whole Ad ate less Ch ate less
day Healthy growing day leaving for
captured the same severity, as they did in the 11-item scale. without Food healthy without Ch
In this round, the item BAdult worried about food sufficiency^ eang eang
was removed because it was redundant with the other two Infit min max

items. Also its severity ranking was higher than expected, EBIA- six item severity values. Brazil 2012.
specifically, according to the theoretical framework behind 10
the food insecurity scale. BWorried^ is expected to be the 9 9.0
8
condition with the lowest severity that precedes the food inse- 7 8.0
severty

curity stages involving compromising first dietary quality 6 6.0

5 5.7
followed by dietary quantity. 4 3.8
In the third round of Rasch analysis, the nine remaining items 3 3.5
2
had infit values ranging from 0.78, Bchildren ate less^ to 1.22, HH Ch food Ad ate Ch ate less Ad whole Ch whole
BHousehold enough food^. However, two items still had a sim- Healthy growing less day day
ilar severity of 4.78: BHousehold enough food^ and BChildren Food healthy leaving for
Children
without without
eang eang
food for growing healthy^. Of the two remaining redundant
items, the item BHousehold enough food^ was removed be- Abbreviaons: Ad, adult; Ch, child; HH, household; F, food

cause it had a higher infit value (1.22) leading to an 8-item scale. Fig. 2 EBIA-G six item infit values and severity. Brazil 2012
1554 A. Segall-Corrêa et al.

first followed by diminution in food quantity first among
adults and last among children.
The cut off points derived from the analyses for the 6-item
EBIA-G were: food secure (score = 0), mild food insecurity
(1–2), moderate food insecurity (3–4), severe food insecurity
(5–6). These are based on the clear severity gradients and
corresponding plateaus. The gradient range was 3.5 to 3.8
corresponding to BHousehold healthy foods^ and BChildren
food for growing healthy^, 5.7 to 6.0 Badult ate less, leaving
food for children^ and Bchildren ate less^ and 8.0 to 9.0 to
Badult the whole day without eating^ and Bchild whole day
without eating^.
3.2 EBIA-G external validity
The EBIA-G measurement showed that only 11.5% of
households were food secure, 28.7% experienced mild
food insecurity, 28.7% moderate food insecurity and
31% severe food insecurity. There were significant associa-
tions in the expected direction between the increase in
food insecurity, severity and worse social status indicators
(Table 3).
Moderate/severe food insecurity was 27.8% higher in
households where the head of household didn’t read
Portuguese compared with those who did. The ability to read
in Portuguese may protect against food insecurity by improv-
ing the capacity of understanding and dealing better with en-
vironments beyond their communities. Although the variables
head of household with lower schooling and women headed
household showed a higher prevalence of severe food
insecurity the differences didn’t reach statistical signifi-
cance. Severe food insecurity prevalence was significantly
higher in households with children and also where nobody
had a stable job salary.
3.3 The final scale items changes suggested
by interviewers
The 6-item scale was considered appropriate in terms of num-
ber and content of items. However, the Guarani interviewers
identified the need to improve the grammatical structure of
some of the questions. Specifically they recommended that
the response options be reverted from Bno, never^/Byes only
a few times^/Byes many times^ (as suggested during the qual-
itative phase of study) back to Byes/no^ because they felt it
would facilitate the flow of the interview process when apply-
ing EBIA-G. The interviewers also recommended for the ref-
erence term Bchildren and youth under 16 years of age^ to be
substituted with Bchildren and youth^.
Consensus between researchers and interviewers was
reached and recommended for the 6-item EBIA-G with the
replacement of the term Bsometimes^ by the word Balways^ in
the first and fourth scale items. For the rest of the items the
advisory group recommended including the term Bany day^ to
make it clear that in the former case questions referred to every
day and in the latter case the questions referred to any of the
days during the month preceding the interview (Fig. 3).
4 Discussion
The great social and cultural diversity of Brazil did not repre-
sent an obstacle for the development of a single national scale
to assess household food (in)security reliably in both urban
and rural populations (Pérez-Escamilla et al. 2004; Segall-
Correa et al. 2009). The research that led to EBIA however
involved working only with Brazilians whose first language
was Portuguese. The multiple languages used across
Indigenous communities in Brazil and cosmovision regarding

Table 3 Observed food security/mild food insecurity and of moderate/severe food insecurity prevalence, according to household selected social
indicators. Guarani people, São Paulo-Brazil, 2012

Variables Food security or mild food insecurity Moderate or severe food insecurity

Categ. N % N % p value

Schooling of the person in charge of the household (Years) Up to 5(67) 24 35.8 43 64.2 0.210
6 or + (26) 13 50.0 13 50.0
Woman in charge of the household No(67) 29 43.3 38 56.7 0.180
Yes (31) 09 29.1 22 70.9
Person in charge of the Household read Portuguese No(19) 03 15.8 16 84.2 0.048*
Yes(78) 34 43.6 44 56.4
Family members have regular salaries** None (81) 26 32.1 55 67.9 0.007*
1 or + (17) 12 70.6 05 29.4
Household has children under 16 years old No (34) 18 52.9 16 47.1 0.0369
Yes(64) 20 31.2 44 68.8

*Yates corrected Fischer exact test

** Regular salary: None/ 1 or more members had regular wage
The Brazilian food security scale for indigenous Guarani households: Development and validation 1555

Português Guarani English

1 No mês passado vocês nesta Ko jasypaha akuepepa, During the last month, did all of
casa comeram sempre comida penderogapeguá peúpa hetaseve you in this household always eat
saudável (boa para a saúde) tembiú resãipa? Tembiú porã? healthy food (good for health)?

?Sim □ Não □ he‘ẽ □ nahániri □ Yes □ No □

2 No mês passado, teve dia de
você passar o dia todo sem
comer nada, porque não tinha
comida na casa?
Sim □ Não □
3 No mês passado, teve dia de
você comer menos comida para
deixar comida para as crianças?
Ko jasypaha akuepepa, peteĩ ára
pe’ẽ ohasa pepyta mba’eve pe’uyre
ndaiporigui pende rogape?
he‘ẽ □ nahániri □
Ko jasypaha akuepepa, peteĩ ára
pe’ẽ ohasa michive tembi’u peúpa
peheja haguã pene mitãkuerape?
During the last month, was there
any day when you spent the whole
day without eating because you
didn’t have food at home?
Yes □ No □
During the last month, was there
any day that you ate less to leave
food for the children?

Sim □ Não □ he‘ẽ □ nahániri □ Yes □ No □

4 No mês passado as crianças e Ko jasypaha akuepepa, nde During the last month, the children
jovens da casa comeram ra’ykuera nde roypegua ho’u porã and youth in the household were
sempre comida que faz crescer tembi’u omongakuaa va’erã always able to eat food that makes
com saúde ichupekuera tesãi reheve them grow healthy

Sim □ Não □ he‘ẽ □ nahániri □ Yes □ No □

5 No mês passado teve dia das
crianças e jovens comeram
menos quantidade de comida do
que precisavam, porque tinha
pouca comida na casa?
Sim □ Não □
6 No mês passado teve dia das
crianças e jovens da casa
passaram o dia todo sem comer
e foram dormir querendo comer
porque não tinha comida?
Ko jasypaha akuepepa, nde During the last month was there any
ra’ykuera nde roypegua ho’u sa’ive day that the children and youth ate
tembi’u ndapeguerekoigui less than what they should because
mba’eve? there was little food in the
household?
he‘ẽ □ nahániri □
Yes □ No □
Ko jasypaha akuepepa, nde During the last month, was there
ra’ykuera nde roypegua opyta any day when children and youth
mba’eve ho’uỹre pe’ẽ went for a whole day without eating
ndaguerekoigui tembi’u ha oke or went to bed hungry because there
higuai ho’use reheve? was no food?

Sim □ Não □ he‘ẽ □ nahániri □ Yes □ No □

Fig. 3 Portuguese, Guarani and English version of the Brazilian food security. Scale for Guarani Indigenous People- EBIA-G.

the origin, access and meaning of different foods and dietary
patterns justified the need to embark on the construction and
validation of a food [in]security scale suitable for application
in studies of Indigenous peoples, the Guarani people in this
instance, seeking to understand barriers to access and con-
sumption of a healthy diet.
The EBIA-G was constructed based on both the food inse-
curity experience, understanding and knowledge of the Guarani
and the theoretical foundation behind the experience-based
scales developed and tested across different cultures and social
contexts (Coates et al. 2006; Swindale and Bilinsky 2006). It is
important to emphasize that EBIA_G structure and language
used here were decided with strong input from the Guarani
community (i.e. strong face validity). Thus the resulting
EBIA-G was not just a translation of the EBIA used with the
general population. This study demonstrates that house-
hold food insecurity can be measured among the
Guarani with an experience based-scale, similar to EBIA,
which in turn is derived from the US Household Food
Security Measurement Module.
The findings from this study show that it is indeed possible
to use an experience-based scale to assess household food
insecurity among the Guarani, and they fully support a com-
mon understanding of key aspects of food insecurity vis-a-vis
the general Brazilian population (Segall-Corrêa et al. 2009,
2010).
Studies conducted in diverse countries (Coates et al. 2006)
had previously suggested the presence of key food insecurity
concepts and experiences that were common across highly
diverse cultures. Studies with Indigenous people in
Canada, using a household food security scale adapted
from the HFSSM from the USA (Teh et al. 2017; Huet
et al. 2012; Willows et al. 2008; Canada 2004; Council
of Canadian Academies 2014), and a food security scale
locally validated with predominantly Indigenous people
in Mexico, have shown their appropriateness in revealing food
access vulnerability in those populations (Melgar-Quiñonez
et al. 2005). These findings fully support the results we ob-
tained while developing and validating EBIA-G with the
Guarani people.
The EBIA-G includes items related to food insufficiency
and poor dietary quality among adults as well as children/
youth. An exception found in our study as well as in studies
conducted in other communities living in extreme poverty
1556
such as Haiti (Pérez-Escamilla et al. 2009) was that the
Bworry^ item was more severe than expected. This may be
the result of the perceived severity of the Bworry^ item in
communities that are chronically experiencing extreme mate-
rial poverty. EBIA-G does not include the Bworry^ item be-
cause it was redundant with information provided by other
items. Thus the Rasch analysis results provided us with a 6-
item scale with strong internal psychometric validity.
Findings also point out that EBIA-G identified the condi-
tions of vulnerability of households’ access to food in insuffi-
cient quantity and inadequate quality. Mainly, EBIA-G showed
the expected associations with socialdemographic indicators,
such as head of household’s inability to read Portuguese,
household members without regular salaries, and also the ex-
istence of children/youth younger than 16 years old, all of them
increasing the prevalence of food insecurity, mainly severe FI.
Therefore, the 6-item EBIA-G is a scale with high external
validity and capacity to identify conditions that indirectly relate
to food security in households with children and youth.
Consistent with previous studies in Indigenous communities
in Brasil (Guimarães 2013; Fávaro et al. 2007; Franceschini
2016) and elswhere (Willows et al. 2008; Melgar-Quiñonez
et al. 2005; Council of Canadian Academies 2014) our results
show that household food insufficency and inadequacy is per-
vasive in Guarani communities.
Household food insecurity among Indigenous communi-
ties is a condition strongly tied to the history of Brazil
(Franceschini 2016). Future policies and programs to promote
food security among Indigenous people need to take into ac-
count the fact that many Indigenous communities frequently
migrate from one village to another, and seek monetary assis-
tance and also some kind of precarious job outside their com-
munities as strategies for ameliorating food insecurity (Segall-
Correa et al. 2010; Gordon 2006; Gugelmin and Santos
2001).We expect that EBIA-G will help to improve food se-
curity governance among Indigenous communities in Brazil
as has happened for the whole population through the use of
EBIA (Perez-Escamilla 2012).
It is important to take into account that in spite of strong
commonalities across cultures regarding the household food
insecurity experience, we need to further understand if EBIA-
G functions well among other Indigenous ethnic groups in
Brazil who speak languages other than Guarani and ex-
perience different living conditions. Following that need
this version of EBIA-G was further used, by FIAN-
International, in 90 Guarani Kaiowa households in the
state of Mato Grosso located in the western region of
Brazil with very promising results (Franceschini, 2016).
Furthermore, a new study is being launched by our research
group to replicate the validation process among different eth-
nic groups in the Parana and Amazon region states starting
with the 11-item EBIA suggested by the Guarani research
experience. We expect that this work will be instrumental in
A. Segall-Corrêa et al.
reaching consensus on the composition of a national EBIA-I
(EBIA-Indígena) for inclusion in nation wide surveys focus-
ing on the household food insecurity condition in the very
diverse Indigenous communities of Brazil.
5 Conclusion
Our findings show that EBIA-G has strong face validity and
psychometric validity and captures universal dimensions of
the food insecurity construct such as hunger and lack of access
to appropriate dietary quality and quantity. However, it
doesn’t capture the Bancestral^ dimension of food security
(i.e., need for spiritual foods that connect humans to their
ancestors) identified by the Guarani in the qualitative research
phase as being crucial for attaining food security. Confirming
this Bancestral dimension^ in other ethnic groups and finding
ways to incorporate it into the measurement of household food
security can improve our understanding of the concept of food
security among traditional indigenous societies.
The EBIA-G resulting from this study is likely to lead to a
consensus EBIA-I once further testing is done with other
Indigenous ethnic groups. Along with other social, economic,
environmental and health indicators, the final Indigenous food
[in]security scale will allow decision makers to better under-
stand how to target and what impact their efforts are having at
alleviating food insecruity among some of the most vulnerable
population groups in Brazil. There is no doubt that an EBIA-I
will have a considerable potential to become a tool that can
help improve food security governance on behalf of the
Indigenous communities in Brazil as it does for the general
Brazilian population.
Funding agencies National Council for Scientific and Technological
Development-CNPq (Process: 401176/2005). Support Fund for
Teaching, Research and Extension, FAEPEX/UNICAMP (Process
519.294 aux) 141/11.
Compliance with ethical standards
Author disclosures Ana Maria Segall-Corrêa; Leticia Marín-Leon;
Marta Maria Azevedo; Maria Beatriz R. Ferreira; Deoclécio Rocco
Gruppi; Daniele F.M. Camargo; Rodrigo Pinheiro T. Vianna; Rafael
Pérez-Escamilla declare that they have no conflict of interest.
Ethical The research project was approved by the Ministry of Health
Human Subjects Research Ethics Committee (CONEP N° 1102/2006).
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Correa, A. M. (2007). Psychometric properties of a modified US-
household food security survey module in Campinas, Brazil.
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Moura, P. G. d., Batista, L. R. V., & Moreira, E. A. M. (2010). População
indígena: uma reflexão sobre a influência da civilização urbana no
estado nutricional e na saúde bucal. Revista de Nutrição, 23, 459–
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1558 A. Segall-Corrêa et al.

Orellana, J.D., Cunha M; Santos R.V., Coimbra Jr. C.E., Leite M.S (2011) Ana Maria Segall-Corrêa, PhD,
Prevalência e fatores associados à anemia em mulheres indígenas was associate professor of
Suruí com idade entre 15 e 49 anos, Amazônia, Brasil. Rev. Bras. Epidemiology for 27 years (re-
Saude Maternité Infant., Recife, v. 11, n. 2, p.153–161, https://doi. tired), at the Faculty of Medical
org/10.1590/S1519-3829201100020000 Sciences (FCM), Department of
Perez-Escamilla, R. (2012). Can experience-based household food secu- Collective Health-State University
rity scales help improve food security governance? Global Food of Campinas-UNICAMP São
Security, 1(2), 120–125. https://doi.org/10.1016/j.gfs.2012.10.006. Paulo – Brazil. At presentl she is
associate Researcher at the
Pérez-Escamilla, R., Segall-Corrêa, A. M., Kurdian Maranha, L.,
Program of Food, Nutrition and
Sampaio, M. D. F. A., Marín-León, L., & Panigassi, G. (2004). An
Culture at Oswaldo Cruz
adapted version of the U.S. Department of Agriculture food insecu-
Foundation-Brazil. Her main area
rity module is a valid tool for assessing household food insecurity in
of research is food security studies,
Campinas, Brazil. The Journal of Nutrition, 134(8), 1923–1928.
having worked as coordinator of a
Pérez-Escamilla, R., Dessalines, M., Finnigan, M., Pachón, H., Hromi-
multicenter research project aiming
Fiedler, A., & Gupta, N. (2009). Household food insecurity is asso-
to validate household food security measurement scales (EBIA) for
ciated with childhood malaria in rural Haiti. The Journal of
Brazilian urban and rural populations, and an equivalent tool applicable to
Nutrition, 139, 2132–2138. https://doi.org/10.3945/jn.109.108852. indigenous people and others traditional ethnic groups in Brazil. She is a
Radimer, K. L. (2002). Measurement of household food security in the Senior Staff Member of the Brazilian National Council for Food and
USA and other industrialised countries. Public Health Nutrition, Nutrition Security (CONSEA) and also a member of the inter-ministerial
5(6a), 859–864. https://doi.org/10.1079/PHN2002385. chamber (CAISAN) which is responsible for monitoring Brazilian food
Segall-Correa, A. M., Perez-Escamilla, R., Marín-León, L., Yuyama, L., security public policies.
Vianna, R. P. T., Coitinho, D., et al. (2009). Evaluation of household
food insecurity in Brazil: validity assessment in diverse sociocultural
settings. In: FAO-INICIATIVA AMERICA LATINA E CARIBE
SIN HAMBRE (Ed.). Concurso RedSan 2007,. v. 1. Santiago-
Chile,: Oficina Regional FAO-Chile. 80–101. Available in http://
www.bvsde.paho.org/texcom/nutricion/memredsan_3.pdf. Dr. Leticia Marín-Leon obtained
Segall-Correa, A. M., Azevedo, M. M., Ferreira, B., Kepple, A. W., & her PhD in Epidemiology from
León-Marin, L. (2010). Perception of food insecurity among indig- the University of Campinas,
enous Guarani communities in the state of São Paulo, Brazil. The Brazil. She was Professor for un-
FASEB Journal, 24(1 Supplement), 104–106. dergraduate and graduate students
Smith, E. V., Conrad, K. M., Chang, K., & Piazza, J. (2002). An intro- at the Department of Collective
duction to Rasch measurement for scale development and person Health, State University of
assessment. Journal of Nursing Measurement, 10(3), 189–206. Campinas, Brazil until 2016 and
https://doi.org/10.1891/jnum.10.3.189.52562. is now a researcher in the
Socioambiental, I. (2017). Povos Indígenas no Brasil. https://pib. same department. Measurement
socioambiental.org/en/povo/guarani-kaiowa/552. Accessed July 24 of household food insecurity at
2017. the national and local level, its
Swindale, A., & Bilinsky, P. (2006). Development of a universally appli- consequences and determinants
cable household food insecurity measurement tool: Process, current have been one of her main re-
status, and outstanding issues. The Journal of Nutrition, 136(5), search topics since 2004. She
1449S–1452S. participated in the validation of
the Brazilian Household Food
Teh, L., Pirkle, C., Furgal, C., Fillion, M., & Lucas, M. (2017).
Insecurity Scale (EBIA).
Psychometric validation of the household food insecurity access
scale among Inuit pregnant women from northern Quebec. PLoS
One, 12(6), e0178708. https://doi.org/10.1371/journal.pone.
0178708.
Vargas, L. C., Souza, R. d. S., Sufiate, C. B., Santos, E. M. d., Sipioni, M.
E., & Rezende, A. M. B. (2013). Segurança Alimentar e Nutricional Marta Maria do Amaral
entre os Guaranis Mbyá da Aldeia Boa Esperança, Aracruz, Espírito Azevedo is an Anthropologist and
Santo, Bra. [Original]. Revista da Associação Brasileira de has a PhD in Demography. She is a
Nutrição, 5(1), 8. researcher at the Center for
Verdum, R. (2003). Mapa da fome entre os povos indígenas: uma Population Studies and professor
contribuição à formulação de políticas de segurança alimentar no of the Pós Graduate Program in
Brasil. Accessed February 2017. http://revistas.ucpel.tche.br/index. Demography at the State
php/rsd/article/viewFile/512/455. University of Campinas. She has
Vianna, R. P. T., Hromi-Fiedler, A. J., Segall-Correa, A. M., & Pérez- worked with indigenous peoples
Escamilla, R. (2012). Household food insecurity in small munici- in Brazil mainly with the themes
palities in northeastern Brazil: A validation study. [journal article]. of methodologies for demographic
Food Security, 4(2), 295–303. https://doi.org/10.1007/s12571-012- data, food security and demograph-
0181-4. ic dynamics and quality of life in-
Willows, N. D., Veugelers, P., Raine, K., & Kuhle, S. (2008). Prevalence dicators. She has extensive experi-
and sociodemographic risk factors related to household food secu- ence with the Guarani in Mato
rity in aboriginal peoples in Canada. Public Health Nutrition, 12(8), Grosso do Sul and in the region of
7. https://doi.org/10.1017/S1368980008004345. Alto Rio Negro, Amazonas.
The Brazilian food security scale for indigenous Guarani households: Development and validation
Maria Beatriz R. Ferreira has a
PhD in Anthropology from the
University of Texas, Austin,
United States. She graduated and
has a Masters Degree in Physical
Education from the University of
São Paulo. She retired as
Professor at the Faculty of
Physical Education at UNICAMP
but is Visiting Professor at the
Catholic University of Leuven in
Belgium, the State University of
the Western Center of Paraná and
the Faculty of Education at the
Federal University of Grande
Dourados of Mato Grosso do Sul. Currently, she develops projects with
teams at the Laboratory of Advanced Studies in Journalism at UNICAMP
in the area of Indigenous Peoples and Sport and also at the Nucleus of
Research in Inclusion, Motion and Distance Learning at the Federal
University of Juiz de Fora. Research interest cover cultural diversity and
inclusion, gender, indigenous peoples’ games and food security and
figurational sociology.
Deoclécio Rocco Gruppi has a
PhD in Physical Education from
the University of Campinas, São
Paulo, Brazil. He graduated in
Physical Education at the
University of Mogi das Cruzes
a n d ob t a i n e d a M a s t e r s in
Education from the University of
Piracicaba, São Paulo. He is a
Professor at the Faculty of
Physical Education at
UNICENTRO. Currently he de-
velops projects with the teams of
the Laboratory of Cultural Studies
at UNICENTRO in the area of
Indigenous Peoples and Sport and also at the Nucleus of Research in
Inclusion. Research interests comprise cultural diversity and, indigenous
peoples’ games and food security and figurational sociology.
1559
Daniele F. M. Camargo, PhD is a
nutritionist with a PhD in
Epidemiology and Masters in
Collective Health, both from the
state University of Campinas/SP
– UNICAMP. She obtained her
PhD degree in 2017 with a thesis
on obesity and environment. Her
main research areas are food secu-
rity, obesity and breastfeeding. At
present,she is a Professor at the
School of Nutrition at University
San Francisco, Brazil.
Rodrigo Pinheiro de Toledo
Vianna , PhD is Professor of epi-
demiology at the Department of
Nutrition, Federal University of
Paraiba, Brazil. His work focuses
on household food insecurity
measurement at the local level
using experience based scales,
household food insecurity conse-
quences, and infant feeding pat-
terns and determinants. His pio-
neer work in Paraiba was instru-
mental in the development of the
B r a z i l i a n Ho u se h ol d F o od
Insecurity Scale (EBIA). He ob-
tained his PhD in epidemiology from the University of Campinas, Brazil.
Rafael Pérez-Escamilla , Ph.D. is
Professor of Epidemiology &
Public Health, Director of the
Office of Public Health Practice,
and Director of the Global Health
Concentration at the Yale School
of Public Health. His global pub-
lic health nutrition and food secu-
rity research program has led to
improvements in breastfeeding
programs, iron deficiency anemia
among infants, household food
security measurement and out-
comes, and community nutrition
counselling and education pro-
grams. His health disparities research involves assessing the impact of
community health workers at improving behavioral and metabolic out-
comes among Latinos with type 2 diabetes. He has published over 190
research articles, 2 books, and numerous journal supplements, book chap-
ters, and technical reports.